The current shortage of primary care physicians is expected to continue as Baby Boomer physicians retire. Addressing the shortage—particularly among medically underserved populations—demands creative problem-solving.
One potential solution: Involving medical residents in providing care to patients in medically underserved areas. Addressing a recent Josiah Macy Jr. Foundation report on graduate medical education (GME), Macy Foundation president George E. Thibault, MD said that healthcare organizations need to empower residents, writing, “But the excitement and the future of GME lie in seeing it as a tool to improve the health of the public, to address health disparities and to deal with the broader social determinants of health.”
Increasingly, medical schools are offering training—usually specific to rural or urban underserved—to engage future physicians with these key populations. By adding instruction on psychographic segmentation, medical schools can also better prepare them to drive patients’ engagement in their own health. Psychographics pertain to people’s values, attitudes, lifestyles and personalities, and are key to patient motivations and communication preferences. Psychographic segmentation drives efficiencies in targeting patients with the most effective messaging. (Keep reading for more about this.)
Training Focused on Medically Underserved
Areas and Patients
The Macy Foundation report noted that California, Georgia, Mississippi, Nevada, Texas and Washington all have state funding initiatives to support GME programs designed “… to address the physician shortage and to increase the number of doctors in rural or underserved areas.” Here are three ways medical residents can step into the care gaps.
1. Using partnerships to open doors
One theme that surfaced in the Macy Foundation report centered on the need for collaboration. Dr. Thibault noted, “Residency programs and sponsoring institutions will need new partners to adequately train residents for all needed career pathways and to make more contributions to the health of the communities they serve.”
The Alaska Pediatrics Residency Track through the University of Washington and Seattle Children’s puts residents in place in high-risk native population communities for four months of each year of their studies. Residents split their time in Alaska between clinical instruction in Fairbanks and Anchorage and the rural town of Bethel, as well as traveling to more remote locations.
In 2015, the program graduated its first group of physicians who “experienced first-hand what it is like to be a primary-care pediatrician in the most northerly reaches of the United States.” One resident says the program has shown that it’s never safe to assume, right down to the type of transportation a patient will use to return home.
The program, which is now touted as a model for other specialties, benefits medically underserved populations and delivers meaningful experiences that impressed one Illinois-native so much that she accepted a position to practice in Anchorage upon graduating.
2. Teaching residents how to engage patients more effectively
Patient engagement is always important, but among medically underserved populations, engagement is even more critical. While underserved populations may share some features in common—low-income, age, geography or even chronic conditions—they don’t all think alike.
And, they won’t all respond in the same way to doctor-patient communications because they have unique attitudes and motivations when it comes to health and wellness—the definition of psychographic segmentation.
c2b solutions has identified five unique psychographic segments among healthcare consumers:
- Self Achievers (24%): The most proactive and wellness-oriented segment. Self Achievers are goal oriented and need ways to measure progress toward their goals to stay motivated. They are the most likely to invest in their health and appearance.
- Balance Seekers (18%): The second most wellness-oriented group, but they are very self-sufficient and are the least likely to consider physicians the most credible source of healthcare information. They want options and choices and like to research topics of interest.
- Priority Jugglers (18%): Reactive in healthcare for themselves, but will make sure their loved ones get the care they need. Priority Jugglers manage many responsibilities and tend to sacrifice their own well-being for other commitments.
- Direction Takers (13%): Reactive in healthcare but higher utilizers of the system. They require directive guidance from healthcare professionals and defer to their judgment. They are not Direction Followers, however, and may not act on clinician recommendations unless they can integrate them into their daily routine.
- Willful Endurers (27%): The most reactive segment, often disengaged from health and wellness. Willful Endurers live for the moment and immediate gratification; if a clinician cannot explain how the Willful Endurer can benefit from a care plan today, they may not follow it.
Each psychographic segment has its own motivations, priorities and keys to behavior change. The most effective communications (e.g., education, intervention, marketing, etc.) will be customized with segment specific words and phrases.
While all five psychographic segments appear across all patient populations, the distribution of the segments may differ. Note, however, that the Willful Endurer segment is overdeveloped among certain populations often associated with medically underserved populations. Important to keep in mind is that “medically underserved” does not mean disengaged in healthcare. The Self Achiever segment is also overdeveloped among African Americans.
By integrating psychographic segmentation into training, residents learn how to communicate with patients more effectively so patients are motivated and engaged to follow care plans and to adopt healthier behaviors.
3. Immersion programs at medical colleges
AAMCNews, published by the Association of American Medical Colleges, notes that nearly 24 percent of residents graduating between 2005 to 2014 practiced in medically underserved areas. To address challenges with access to care in rural areas, medical schools use immersion programs to enable residents to “learn in the field.”
After spending their first two years at the University of Wisconsin medical school main campus, for example, students at the Wisconsin Academy for Rural Medicine (WARM) spend their final two years at one of three regional sites that are gateways to rural communities, each with a different training approach designed to meet the needs of residents and medically underserved patients.
Tulane University School of Medicine has a similar program based on the WARM model. Another program at Commonwealth Medical College matches students with a single family—from their first year of medical school until graduation—to help them learn about the community from a more personal perspective.
The University of Texas Rio Grande Valley School of Medicine uses a similar approach, engaging first year students with family medicine clinics medically underserved areas. Dr. Francisco Fernandez, founding dean of the Rio Grande Valley School of Medicine, says: “They are not just starting early; they are starting in a unique environment. It will help students better understand the needs of their patients in their environments.”
It’s not just rural underserved areas that benefit from these types of programs. The University of Wisconsin School of Medicine and Public Health also has a program—The Training in Urban Medicine and Public Health program (TRIUMPH)—that immerses students in primary-care residencies in underserved cities. More than half of graduates who have completed their residency, elected to practice in urban areas.
The physician shortage will continue even as medical students graduate. But as medical schools partner with other organizations, teach students how to engage patients more fully using psychographic segmentation, and immerse residents in caring for medically underserved populations, all parties win. The residents receive valuable experience while providing much needed care to the patients who previously struggled to access healthcare.